Summary
This Care Lab episode explores Vivistim vagus nerve stimulation paired with intensive therapy as a breakthrough approach to stroke recovery — even years after stroke. Occupational therapist Ashley Mahoney explains the science behind reopening neuroplasticity, who qualifies, what treatment looks like, and why motivation and functional, task-based therapy are essential for meaningful gains. The conversation emphasizes progress over perfection and highlights real-world improvements in independence and quality of life.
Key Questions Answered
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How does Vivistim improve stroke recovery?
It stimulates the vagus nerve during therapy, releasing neuromodulators that enhance neuroplasticity, allowing the brain to relearn motor skills more effectively. -
Who qualifies for Vivistim treatment?
Individuals with chronic ischemic stroke who fall within a specific functional range, can move their arm somewhat, and are motivated to participate in intensive therapy. -
What does therapy with Vivistim look like?
Patients complete 90-minute, task-specific therapy sessions multiple times per week while stimulation is active, plus home-based functional practice. -
Does Vivistim help with more than just arm movement?
Clinicians report gains in balance, walking, speech, and cognition, though FDA approval currently covers upper extremity function only. -
Is Vivistim a cure or a replacement for therapy?
No — it enhances the brain’s ability to relearn, but recovery still requires high-repetition, meaningful functional practice and patient motivation.
Transcript
Emilia Bourland
What if stroke recovery didn't have an expiration date? In today's episode of Care Lab, we are uncovering the groundbreaking medical techniques that are helping survivors regain function, sometimes years after their stroke. From neuro-stimulation to high intensity retraining, these are advances that are rewriting what's possible in long-term recovery. If you thought the window for progress had closed, you may wanna think again.
Ashley Mahoney, OTR/L
you
Brandy Archie
Thank
Ashley Mahoney, OTR/L
Okay.
Brandy Archie
And we get to have this great conversation with Ashley Mahoney, who's an occupational therapist and her second time on the podcast. Last time she was on, she talked to us about how you should have an occupational therapist as a realtor and all the wonderfulness about that. So you should go back and listen to that episode. But she also has spent a good amount of her career working as a clinician, working with stroke survivors. And in the past seven years,
She has developed an advanced outpatient rehab clinic with dedicated PTs, OTs, and speech therapists who specialize in some of the newest stroke recovery advanced technology, including VivisTen. Ashley, we're so glad that you're here.
Ashley Mahoney, OTR/L
Thank you guys for having me again. I was super excited when you asked me to talk about this because it's something I'm super passionate about.
Emilia Bourland
Yeah, can I just start by saying that like everything I just said in the intro is something that I Never would have thought as an occupational therapist in the first several years of my practice that I would say because The way that stroke recovery has always been is like you get the most Recovery in the first six months you continue to get recovery up through the first year And then it's not like you can't continue to recover or have changes after that time
Brandy Archie
Yeah!
Emilia Bourland
but it's much, much slower. And then at certain point, you've reached basically your maximum gain and that's where you're gonna be and you have to sort of just like work to maintain that. That's always been the science behind it and the rules. And those are changing now. So tell us a little bit about what's going on there.
Ashley Mahoney, OTR/L
Yeah, it's super exciting. I like I said OT as well. So I most of my career I did work with stroke patients at a level in trauma center and a rehab unit So I would see them, you know the first chunk of their time there You know whether it was the first three months or sometimes even the first six months and it was great because you could constantly see them progress but then towards the end of my treatment career I started seeing patients in an outpatient setting where you know, it was further out You know more that three months to like years out
Brandy Archie
Okay.
Ashley Mahoney, OTR/L
and it was just almost like defeating when you'd have someone come in after eight years of a stroke and he's like, I want my hand to get stronger and it's like, okay, you can't really move it much, like let's go ahead and try some eSTIM just to watch it move while we're trying to do stuff to see if we can get any kind of stimulation in your brain and get regrowth and get something out of it, but you never see anything come about that was very significant.
you might be able to help a little bit with some spasticity and you might be able to help a little bit with range of motion, but general strengthening is kind of hard if their muscles aren't even moving right. anyways, that all, you know, it's kind of sad as an OT when your job is to really just help people get better. And so when you have people come back that aren't just looking for adaptations and how to function, but they want to get better after a stroke, it's just like super disheartening. So I met with,
I do not work for Viviston or microtransponder. I do not work for the company. get no financial gains from them just to start this off. Um, but I met with someone who did work for them. It was two December's ago now in Kansas city and they'd been around for quite a while and doing treatment since 2022. Um, so just in the big cities, this was a thing, but they were moving to Kansas city and starting to like get their ground or their feet wet in Kansas city.
Brandy Archie
you you
Ashley Mahoney, OTR/L
And I was like, yeah, sure, I'll meet with you. You just think it's another salesy thing and you're like, whatever. And I met with this gentleman who worked for the company Microtransponder that has the Vivistim device. And when he told me the research, I mean, I could not stop asking questions. I was like, I am not a gullible person and I feel like this is legit and mind blowing for what this could do for stroke patients. Anyone who's had an ischemic stroke, at least right now, is on the radar.
Brandy Archie
Okay. Okay.
Ashley Mahoney, OTR/L
800,000 strokes happen a year. That's the stat in the United States, And 200,000 of those are repeat strokes. But they think about 200,000 of those also could be potential VivisDem clients. So about 87 % of strokes are ischemic strokes. And the last little chunk are hemorrhagic. So it's a huge population that could qualify for this now, because that's what the FDA approval is for. And I'm gonna get a little bit into it. I know I'm kind of just starting at ground level.
but this is like a huge population of stroke patients that could potentially get further help to improve their skills. So it came out that it was just for upper extremity use through the FDA. So right now, that's all they can say through their company is, know, FDA has approved this ischemic stroke treatment for upper extremity.
Brandy Archie
Wait, wait, can you explain to people what the difference between ischemic and hemorrhagic is and also like how that presents in real life, you know?
Ashley Mahoney, OTR/L
magic.
Ashley Mahoney, OTR/L
So they pretty much present the same. So unless you know in your medical history whether you had an ischemic or hemorrhagic stroke, are you're gonna have to go through your medical history or call your physician or your hospital and figure out medical records to see whether you had an ischemic or hemorrhagic stroke. Like I said ischemic is more popular unfortunately, but it is when a clot goes to the brain and then there's death to that area because the area of the brain is not getting blood flow to the area of the brain.
So that's an ischemic stroke. Hemorrhagic is when an artery bursts and then the blood rushes to the brain and it starts killing off those cells. So ischemic is when there's a clot, like if you had plaque in your vessels and it goes up and it gets stuck. So that would be an ischemic stroke, which is way more common of a stroke. So that is what that background is. And both sides can affect similar parts of the brain. Everybody's brain has different things going on in it and everybody's stroke is gonna look different.
But if you had some kind of mobility issues with one of your arms since your stroke, and it was an ischemic stroke, you could potentially qualify for this, or a family member or someone that you know could qualify for this treatment. But like I said, it started up in the bigger cities. Finally, I was getting Kansas City. was like, what is this nonsense? It was a triple-blinded study, controlled study, that blew my mind, okay?
Brandy Archie
Thank
you
Ashley Mahoney, OTR/L
So they had patients who had a chronic stroke, right, they labeled that as, you know, anytime six months post stroke, post their initial ischemic stroke. So they had people like, you know, six months after, years after, like 10 years after, 20 years after, so they had a big chunk of folks do this study and half of them, they all got the implant, so I'm gonna talk about the implant in a little bit, but they all got this device implanted and then they all went through.
strenuous therapy three times a week for six weeks. That was the protocol that was set through the research. So three times a week after their procedure and they had this vagus nerve stimulator is what it is. It stimulates the vagus nerve and we'll get more into that too. They went to therapy for six weeks, three times a week for six weeks and they got 90 minutes of therapy while this vagus nerve stimulator is firing into the brain creating regrowth and neuromodulators and
And it was that study that showed regular therapy, yes, it might help a little bit after stroke when they figured out who had turned it on and who hadn't. But the people that had it turned on during their therapy, they got two to three times better with that upper extremity. So they were like, wow, this is pretty outstanding, okay? And they did a certain objective assessment. It was the Fuglmeyer assessment. So that's something that you would do before you could even get approved. And then you'll do it kind of throughout.
Brandy Archie
Yeah.
Ashley Mahoney, OTR/L
But then they turned everybody else's on who didn't have it turned on. And they also got two to three times better with that upper extremity. So very substantial. I was like, this doesn't seem real. Like I want to see it. And then I met some therapists. They had therapists flown in to train some of our therapists. And they were real therapists who were not working for the company or selling anything. You know what I mean? Like they were like, this is in our clinics. If you have the right person.
Brandy Archie
Mm-hmm.
Ashley Mahoney, OTR/L
So that's part of it too. And so I'll get into that as well. I might dive down the whole background of how you would get it if you want to get it. Is that OK? Or do you guys have questions at this point?
Emilia Bourland
Yeah, yeah, I think... Sorry, go ahead, Brandy.
Brandy Archie
Let me.
I was going to say like, I think that's a great overview. And also I went not through their training, but I did, they had some educational stuff. I had like, actually there, I had so many questions. And I think I probably had like the same experience that you had when you first met with them, because I spent five years doing outpatient neuro in my career. And like that's, I had the same experience that you did and that we made some incremental small gains, which are not nothing, but.
In the grand scheme of things, it wasn't like what they were actually trying to accomplish. And to have that big of a change, especially like 10 years out, five years out, you know, is kind of crazy. And so maybe before we talk about like how you would access it, I just think it's really interesting to think about like, well, why? Why is this so much better? It still needs therapy. You still need a therapist to help you get better. But what is happening with this vagus nerve stimulator that is making it work so much better than just do a therapy alone?
Ashley Mahoney, OTR/L
Yes, and I'm going to talk about that's the sciencey part that I'm not like really good at memorizing So I'm going to read it from the Vivastim site. Okay, I'm going talk a little bit about Because I don't want to do this injustice. Okay, but the vagus nerve Okay, so you have one on the left side and you have one on the right side The right side goes down to the heart. We don't want to fiddle with that, right? But, the left side goes up. So,
Brandy Archie
Okay.
Ashley Mahoney, OTR/L
the vagus nerve is the part of the autonomic nervous system that controls involuntary body movement. So that left side is what we're going after. So when it's stimulated, it sends electrical pulses to the brain that release neuromodulators. So that helps with learning and memory. So that's where strengthening comes in. Because the neural connections are changing at that point. And that is where there's actual chemical change in the brain going on.
when the vagus nerve is stimulated. So if you're doing task specific intense rehab to a certain limb, it's gonna have regrowth. There's gonna be regrowth around that like dead spot in the brain where you had your stroke, where everything can regrow and relearn. And that's kind of the science side behind it.
Emilia Bourland
So I just want to kind of like repeat back kind of for clarity and understanding. Essentially what's happening is when that vagus nerve is being stimulated, it's basically like reopening the opportunity for brain healing, which we often call like neuroplasticity in the rehab world, right? But basically it's releasing these chemicals.
Brandy Archie
you you
Ashley Mahoney, OTR/L
Yes. Yes.
Emilia Bourland
that are making it possible for the brain to actually begin to heal itself again. And so it almost reopens that like really powerful first three months that we say that we have during therapy. Like if there's some movement there, then we need to like really be aggressive in terms of doing a lot of very specific functional work. Like just generally opening and closing a hand isn't going to get you where you want it to be. General strengthening isn't, but like if we can.
Brandy Archie
Thank Okay.
Ashley Mahoney, OTR/L
And it's kind of looking like that from like my findings is right at the beginning there is when you're going to see a lot, but then they can continue this so we can talk about that too.
Emilia Bourland
focus on doing real functional tasks with the limb during that window of brain healing, that's when we see a lot of gains. And it's basically reopening that window. Am I understanding that correctly?
Ashley Mahoney, OTR/L
They can continue this for years. They can continue this forever. Their battery will run out eventually, but they have the ability, not just in clinic, to stimulate the vagus nerve, but at home, they have access to stimulate the vagus nerve as well in different ways. So it's something that like at the beginning, we're seeing huge gains, but then it is petering out after a time, whether it's because they're not doing the intensive six days, you know, might be part of it, but that's the protocol. So a lot of folks in our clinic are seeing people for longer.
Brandy Archie
I'm I'm
Ashley Mahoney, OTR/L
in continuing to seeing gains, but you see the biggest burst towards the beginning, kind of like a traditional stroke.
Brandy Archie
So can you maybe like
Brandy Archie
I guess I don't want to take this off course, but one of the things that I had so many questions about was like, if it is giving us the ability to like have a fertile ground to learn on basically, and it's in that memory and the cognitive part of our brain, stroke has a lot of challenges, right? And so like using your arm is definitely one of them, but it might be your same side.
Ashley Mahoney, OTR/L
Yes.
Brandy Archie
Leg might be challenged, you might have trouble with speech, you might have trouble with memory, you might have trouble with vision. And so I know that they have to be really intentional about what they're studying and what gets FDA approved. But from a scientific perspective, and maybe a just subjective feedback from the patients that are using this, are they seeing other gains as well?
Ashley Mahoney, OTR/L
Yes, yes. Now the company micro transponder probably couldn't tell you that, but me as a therapist out in the field that has seen it, absolutely. Vision, I can't say that we've had any patients that we've really done much with vision on, but for speech like aphasia and lower limb,
Weakness and balance we have 100 % been very lucky to be able to see changes in that and have the ability therapists work on that during their session. Yeah Still getting the 90 minutes, know of just specific upper limb rehab But then also taking some time to stimulate the device and like actually work on balance lower body rehab and cognition or speech. Mm-hmm So I think they're
Brandy Archie
Mm-hmm.
Ashley Mahoney, OTR/L
probably working on studies for that. Like I said, I don't know all of their behind the scenes, but I know that they just had to be very specific to get this approved through the FDA and get it going. It is looking very promising, I think.
Brandy Archie
Yep.
Emilia Bourland
Mm-hmm.
Emilia Bourland
And so, you know, one of the other things that you had said is like a criteria to get it right now is it has to be an ischemic stroke, right? And that's probably be, I'm gonna guess, I don't know this for sure, so forgive me, but I'm guessing that's because that was the population of stroke survivors that was studied. And so that is the population that it was approved for through the FDA because again, it has to be really specific. Do you know if they're doing studies with hemorrhagic stroke survivors right now or if that...
Ashley Mahoney, OTR/L
different right.
Emilia Bourland
hopefully is gonna maybe open up to those folks in the future.
Ashley Mahoney, OTR/L
I've heard talks about it and I've heard potentially being able to pay out of pocket. I don't know for sure about that. That would be something that, you know, when I give the website later that folks could reach out to the team specifically and find out if those are actual capabilities.
Brandy Archie
So maybe now is a good time for us to tell us, how do people find, let's say, I think this is me and my person. How do we like learn more about this and like, what are our, how do we do things to make it happen?
Ashley Mahoney, OTR/L
So they have a great website. It's vivistem.com. So like I said, the company's name is Microtransponder, but the device is V-I-V-I-S-T-I-M. So vivistem.com. All I's in there, no E's, even though it sounds like it could be.
Emilia Bourland
And we can link that in the show notes too, so people can easily find that. Yeah.
Ashley Mahoney, OTR/L
That's best place to go. There's obviously YouTube videos about it. They have videos on their website about it, about like serious gains that people have had and success stories. But they also have folks that you can get a hold of and find out whether you're a therapist or you know a person who survived a stroke or a caregiver, a loved one. They'll have resources for you to either find someone close to you, see if this makes sense for you.
They have all the support there. So even if you're a therapist and you're like, we want to do this in our clinic, they can also go to the website, contact them. They'll put you in contact with whoever's closest to your city because they're expanding. We're in the Midwest. We're like, not a tiny town, but we're not a huge city either. And so they're starting to like really get out there throughout the States and provide this to as many people as possible.
Brandy Archie
Okay.
Emilia Bourland
I had a question and then I had a brain fart. Oh, I know what it was. Okay. So we have talked a lot about like, is pretty incredible. It's one of those things that honestly, when I first heard about it as a therapist, I was like snake oil. Like I'll believe it when I read the research and I see it because there are so many things out there that make big promises to people.
Ashley Mahoney, OTR/L
That's it.
Brandy Archie
Yes.
Emilia Bourland
and frankly can be, are really like predatory and they're just, they're preying on people's hopes to try and get something when like really it's unlikely. And this is, and then, know, I talked to you, Ashley, I saw, like I read research and so this is not that. I just wanna be clear. Like there's great research backing this up. Therapists and patients are seeing outcomes. This is not that. But I think it's,
Ashley Mahoney, OTR/L
Yeah.
Emilia Bourland
Also important to understand that like, every 100 % of people are probably not seeing all these outcomes, right? Or am I wrong here?
Ashley Mahoney, OTR/L
you
No, correct. So there, I was going to get into that eventually and I'm glad you kind of led us that way. There's not just, like you have to have an ischemic stroke to qualify, but you also have to fall within a certain range on the Fugl-Meier assessment that I talked about. There has to be another piece as well. You have to be motivated. So it can't be like a family member wants mom to come in and do this, but mom is like, I'd rather sit on the couch. I'm very depressed. I'm not doing this. Like it doesn't work that way if you're not
Brandy Archie
Yeah. Yay.
Ashley Mahoney, OTR/L
like 100 % going to therapy and doing it and then doing your exercises at home that it calls for as well, then it's not gonna be as good of results. We've had folks in our clinic who we can see on the laptop and they know that we can see what they do at home and how often they're stimulating it. And we're like, hey, what'd you do last night? And my therapist have told me like, people will be like, we would just watch TV, you know, and they weren't doing their exercises and maybe their outcomes weren't quite as well as, know.
the other person that had been doing their exercises and had all the family support and was very motivated. So that's a huge piece is the person has to be in it for themselves. I have to be somewhat cognitively aware to do this, right? Cause if you have someone that's cognition is just completely struggling with like following directions or knowing kind of what's going on, they aren't going to be motivated to do this. Cause why would they, right? Why are they going to work on these hard exercises if they're not quite sure what's going on around them?
Brandy Archie
I'm
Ashley Mahoney, OTR/L
and the Fuglmeyer assessment, it checks a lot of different arm motions, functional arm motions and the way our bodies move. So if you have someone who as therapists, we would call their arm flaccid. But for those who are just on here watching, it's when your arm has no muscle movement left, right? Maybe your loved one or yourself might have a subluxation, your shoulders kind of popping out of the joint and you can't move your whole arm. You might be in a sling all the way down to your hand is not moving.
Brandy Archie
I'm going doing a little bit a little bit a a bit a bit bit bit little bit little bit a little a little little little a a bit a bit little bit little little little little bit bit little little little little bit bit a little little bit little little bit bit bit little little bit little
Ashley Mahoney, OTR/L
then you can't work on intensive high task relearning motions because you can't move it at all. And then there's folks who, you know, they're like, gosh, my typing skills are just a little bit off with my left hand, you know, but they completely look like they're 100 % functional. You wouldn't know. Maybe it's just like a tiny bit of typing, but the rest of their arm is completely strong and moving. Then they're also a little bit too high functioning to really even see much results that they probably wouldn't qualify it.
Brandy Archie
Okay.
Ashley Mahoney, OTR/L
Though it's like that sweet middle ground, like can you at least maybe like try to pick up a tissue out of a tissue box even if you're not using your own properly but you have some muscle strength in there. So it's kind of like that sweet middle ground. That's why they say maybe like 200 out of the 800, you know, would qualify for VivisDem because they have to be motivated wanting to do these exercises and be able to move most or some even a little bit of movement.
in some muscles so that they can work on exercises for 90 minutes straight, task specific exercises.
Brandy Archie
I'm so glad that you clarified that out because it's not that the stimulation of the vagus nerve is the recovery tool. It's that it's paired with the movement. It's kind of like two kids go to school, they both sat there for eight hours, but if one got their sunglasses on and is sleeping, they're not learning nothing. And if the other one is doing their homework and listening to class, they're learning. They're both there at the same place where you're supposed to get the learning.
Ashley Mahoney, OTR/L
So.
Ashley Mahoney, OTR/L
Correct.
Brandy Archie
but you have to have like a fertile bed of like learning behaviors. can't just not just buy osmosis getting the knowledge. And the same thing is happening here is that the vagus nerve is the school. It's allowing you a place to relearn the thing, but you have to like functionally do the things over and over and over because the science previous to this and it still stands true that you need a lot of repetition in order to get those things back. And if you think all the way back, like we call this rehabilitation because we're
Ashley Mahoney, OTR/L
You
Ashley Mahoney, OTR/L
Okay. Okay.
Brandy Archie
rehabilitating something we already learned in the past, but you didn't come out the womb knowing how to write with your hand, right? Like even doing the functions of picking up a pencil and writing, you had to have lots and lots of play and lots of things that taught you those motor skills to get those things back. And so you've got to do the same things in order to get this back. It can come back kind of faster because you knew how to do it already. Then like the years it takes you as a kid to learn these motor skills, but you still got to repeat them over and over.
I would just want to like put an exclamation point on that because that's why the motivation is so important because you really do need a lot of repetition in order to like rehabilitate and get those motor skills back. there been, I guess, if you don't have an answer to this question, it's totally fine. But I'm wondering, like, I always wondered when I was seeing patients, if they could feel more motivated to do this high level of repetition if they saw more progress, right?
Ashley Mahoney, OTR/L
Yeah. Mm-hmm.
Brandy Archie
Like we see that what I'm doing is working, then maybe I'll feel more motivated to do it, which is why we like made like super small goals and like highlighted how important it was that you met that. So maybe you'll meet another one. So the question I have for you is have you had an experience with a client who was maybe said that they were motivated to do it, right? But maybe weren't quite as motivated as they needed to be, but because they did get started and saw the progress happening.
Ashley Mahoney, OTR/L
Yeah. So I've seen both sides. We have a really great success story that I'll probably talk about at some point on here of a gentleman who had like, he was motivated, but so was his wife. They were like both highly motivated.
Brandy Archie
that that did help them ramp up.
Ashley Mahoney, OTR/L
and they were appreciative of every little change that they saw. And then they were able to transform that into daily life things. And so that was very motivating for them. They would talk about this all day long to anyone and everyone, you know, because they had such a great success. But then there's been people, one particular that I'm thinking of that, you know, they came in a little bit skeptical, but wanted to try it to see if it helped. And even though objectively they're getting better because they aren't seeing like a huge change.
they've kind of like stopped doing their other exercises and aren't doing like the things that they need to and then when they get their assessments done they're kind of poo pooing like, nothing really changed, well things have changed objectively but you're only doing half of the work because you kind of stopped. So I've seen a little bit of both.
Brandy Archie
So.
Emilia Bourland
think it's also one of the things that I think is challenging for stroke survivors and I think is challenging as a therapist working with stroke survivors is trying to have clear and realistic expectations too. One, because to a certain extent, like we...
We know we have to do the work. We know that the patient has to do the work. The survivor, like, there is no magic pill, to your point, Brandy. It is still work. Rehab requires effort in order to get that outcome that you want.
I think that what can be really challenging is sometimes we can have in our head that the only acceptable outcome is perfection or being a hundred percent the way it was before. When in fact, a successful outcome, maybe from the therapist's perspective is just an increase in function. So maybe it doesn't look exactly the same way it did before, but you can pick up that.
Brandy Archie
Yeah.
Ashley Mahoney, OTR/L
Correct.
Emilia Bourland
You can dress yourself. You can do these things that you were really struggling to do with that limb or overall before and so going in with the mindset of this is about this is about progress and function not perfection and absolute normalcy and I'm putting like normal in quotes because we all know like that's not necessarily a super helpful word or place to start from but but
Brandy Archie
you you
Ashley Mahoney, OTR/L
Mm-hmm. App.
Emilia Bourland
Do you think that that's a helpful kind of mindset to have for folks who are going into this? This is about progress, not perfection. Where can we get to functionally?
Ashley Mahoney, OTR/L
Yeah. And the therapists that are trained to do these evaluations, these Pugl-Meier assessments that kind of set the patient up for, yes, you should get it. No, maybe you're not a potential candidate. They have to talk about that. Like, so they're trained by the company, microtransponder, wherever they're working, you know, they don't work for microtransponder. They work for whatever outpatient clinic, but they're trained to highly educate the patient on that. Like nobody is going to be what they were before their stroke. Most likely, you know, exactly the same.
but they're gonna see significant gains if they're doing what they're supposed to be doing. That could help change whatever part of your life. Like we have someone who, he's one of the success stories. His wife is like, I don't have to help him as much. Like I've been his caregiver for seven years and now I don't have to help him with certain things and he can do these things again, you know? So like caregiver burden even, you know, it can help with caregiver burden. I mean, they're not young spring chickens, they're getting older and she probably needed that to help them.
get along a little bit longer. You know what I mean?
Brandy Archie
Mm-hmm.
Ashley Mahoney, OTR/L
So yes, I'm glad you brought that up. is not like the magic pill. It is definitely magical, it seems, know, for our OT hearts, but it is not gonna heal someone's brain, obviously.
Brandy Archie
Okay.
Brandy Archie
We've been talking about like functional movements and like lots of exercise, but can you like, and we understand that as OTs we've done this work, but for our listeners, can you talk a little bit about like what that might look like? What does 90 minutes of therapy look like?
Ashley Mahoney, OTR/L
So it will depend on what kind of clinic you go to. Really it will. So I would scope out. I mean obviously if there's in your rural area there's only one clinic close then you know I think these this company is scoping out really good clinics that are set up for success for this device. But if you're in a bigger city scope out all of the different places that you could go to for this because some places have more access to different
know, advanced technology than others. It's like our clinic specifically has a robot like for your hand specifically that's like very intricate, works every different muscle in the hand, you know, you can do active assistive, you can do passive, it does vibration to loosen it up. also like, I mean, if you have spasticity in your arm, you're kind of stuck, you know, in a position, you want to work with a clinic that knows like how to set you up with a physician that can do Botox to prep you.
kind of loosen your hand, know, make sure that you're working with like the most experts of experts that can help you with these treatments because if you go to a treatment center that just has you know maybe some stretchy bands and weights on the wall and maybe some little clippies to you know on putty for your hand you're not gonna get I mean who's motivated to do that right whose brain wants to do that stuff so you want to make sure you're at a very diverse clinic if you can be
that has a lot of different options. So either advanced technology, because now like the robotics that like we have in our clinic, it's like a game that like you're fighting to beat someone or your own self, you know, and your skills. So like you have something you're working towards and it's not just like follow the screen, you know, and watch the thing go up and down and see how you're working. It's like kind of fun, you know, and interactive and a lot of research backs that as well that when you're getting different biofeedback, you know, visually, auditorily, like something that you're enjoying, that's a really good option. So for the hand, I mean,
Brandy Archie
I'm
Ashley Mahoney, OTR/L
You could be working on that for a little bit in our clinic, which is like kind of gaming for the hand, you know. We have arm ones as well, like for the shoulder and elbow. But then we also, like when I'm in there watching therapists work with these patients, they're doing like real tasks. Like I have folks like that are going in and getting like their water with their affected hand, you know, at the drink station. And then they're like working on just putting on a lid with their affected hand and getting the straw unwrapped, you know, with both hands and just using that.
affected hand to put the straw in and then they might take it off and they have to like drink the cup with just their affected hand, which they normally wouldn't do. So we put them through some tasks, like normal daily tasks. But then if there's something that somebody likes to do, gosh, we have one guy who he always gives the therapist trouble and he's like, you're like a drill sergeant. So like every day he had to work on like saluting her, which like he couldn't do it. Like look at this, know.
Brandy Archie
So, thank you.
Brandy Archie
Okay.
Ashley Mahoney, OTR/L
things as simple as shaking hands. He also couldn't shake anyone's hand for seven years. For seven years, this gentleman who, you know, he's older, so, you know, that's something that people take pride in, being able to shake each other's hands. And the day I met him, after he'd already gone through his vivisdom, I got to meet him and talk to him. And I went to shake his hand, and he stuck his hand right out there, proud as ever. He's like, I couldn't do this before. He's like, I couldn't do this before. You know, he was proud as could be, so.
Brandy Archie
you
Ashley Mahoney, OTR/L
just like normal daily tasks that are super important to that individual they'll work on in the clinic if they have access to those things, but then also more intensive strengthening in tasks that maybe some clinics don't have access to as much as others.
Emilia Bourland
So kind of summing that up, like trying to find a clinic that has access to more technology so that can do more advanced things with you. But regardless, no matter where you are, making sure that the activities that you do are like function focused is really, really key versus, know, like I said before, just if you're doing general strengthening, you might get generally stronger, but being stronger doesn't always translate into function because there's so much more.
Ashley Mahoney, OTR/L
Yes.
Brandy Archie
you you
Emilia Bourland
that goes into things besides just strength, right? So again, just looking for those clinics that have more resources, but no matter where, making sure that you are doing functionally focused tasks that are important to you, not to someone else, not to the therapist, but what do you want to do? And that's super motivating too, when you're like, oh my gosh, I haven't done this, and now I can. That's like...
Ashley Mahoney, OTR/L
Mm-hmm.
Emilia Bourland
That's why we're all therapists, right? It's that like magic moment when someone does something that they didn't think that they would ever do again.
Ashley Mahoney, OTR/L
So.
Brandy Archie
Yeah.
Brandy Archie
And I think like the other thing that's super important about that is the science is also backing that fact that it doesn't matter as an OT what activity I choose for you. It needs to be something that you care about. And if you don't care about it, then your brain does not light up in the same way and you don't relearn that task. And so not at the rate at which you could, if you actually motivated to do it. And so basically what VimSIM is doing for us is like,
Ashley Mahoney, OTR/L
Mm.
Brandy Archie
taking all the best practices that we already do as therapists and what we know works for the brain, but then just like putting rocket boosters on it because you are stimulating the vagus nerve, which is saying like, Hey, I'm ready to learn something new. Like I'm prepared for learning and I'm ready to take the stand, but you gotta do all the same stuff. So, I think there's one thing that is not totally clear if people don't know, but it's like, if they want to access this, maybe don't go to a clinic first, but go to Vivisim.
and talk to them about it. If it's appropriate, then they're going to help you find a clinic. If for some reason they're not in your space, in your area, then they'll ask you, like, do you know a clinic nearby that would work for you? And then you would apply these thought processes about what we were saying about, like, do they have technology or do they have a bigger gym or do they have, you know, those kinds of things that you would want to do? Is that kind of like the process they should take?
Ashley Mahoney, OTR/L
Okay.
Ashley Mahoney, OTR/L
So if they don't have anything close to their area, they may have to wait for something to come close to their area or travel somewhere. But yeah, the first step would probably be to contact the company and see whether it even makes sense, you know, and where might I be able to access this because nobody probably could just Google it and think that something's going to pop up. I know for sure our clinic wouldn't just pop up.
So going through their direct website and talking to their, they have a lot of therapists that work for them, nurses, and then folks who are working in with the doctors specifically that would probably be reaching out and contacting you and kind of guiding you. But yeah, once you would contact someone, know where to go, say, then your first step would probably be, depending on the clinic, to get an occupational therapy or physical therapy evaluation. Whoever in that clinic sees these patients to do the initial Fugl-Meier assessment.
And then at that point, once that's completed and the therapist is like, I think you'd be a good candidate. Obviously we don't do the surgery because it is a surgical approach and a little device that's about the size of a key fob that sits under your left collarbone. If someone has a pacemaker, it can go under the right collarbone. And then the little leads just go up to the vagus nerve and hook right in the neck. So there's two little incision spots, but they have to go to a, it's usually a neurosurgeon.
or an ENT that does the surgery because these devices have been used for years for epilepsy patients, similar devices. Same type of, right, vagus nerve stimulation for someone who might be having seizures all the time and have epilepsy and their device is on all the time, right, if you have epilepsy, your device is on all the time. Very simple procedure. Like I said, they've been doing it for years. It's usually an ENT or a neurosurgeon that's already doing these cases. Then Vivistim.
Brandy Archie
And.
Ashley Mahoney, OTR/L
or a microtransponder, I'm sorry, gets certified for the Vivastim procedure. And it's a day procedure. So the neurosurgeon or the ENT would assess these patients after they see therapy with a Fugl-Meier therapist says, yes, go see if the surgeon thinks you're an appropriate candidate, right? And they look at them more for the physical side of like, are you safe? Do you have any reasons why we couldn't be doing surgery under general anesthesia? And then folks that we've heard from, they're in and out.
Brandy Archie
I'm
Ashley Mahoney, OTR/L
within six hours and back home and recovering for about two to three weeks. They'll just have small incision spots. They might feel like their voice has changed a little because they're just up in that area, but everybody has seemed to think that their voice has gone back to normal after a short period of time. And then they won't feel anything because nothing's on. But once they get to the clinic for their 90 minutes of therapy, whether it be with OT or PT, depending on the clinic, that's when they'll...
start feeling maybe like a light buzzing. Some people don't feel anything, but they'll feel the device activate and that's when the vagus nerve is being stimulated. And so you go through it with all these exercises, know, and treatment and clinic, but then you go home and it's, you know, it's off after the clinic is done. You go home, you have a magnet that you swipe over the little device that's under your collarbone and it turns on for 30 minutes. So you don't want to be laying around watching TV when it turns on, right? You want to be up.
Brandy Archie
I'm
Ashley Mahoney, OTR/L
Maybe you're doing dishes, maybe you're going to shower, you know? Maybe you're playing cards with family members, but something that you're like gonna be actively using your arm for. Or maybe you do like to do exercises and the therapist are like, okay, we'll send you home with an exercise, like work on these exercises. So that can happen multiple times throughout the day while they're at home too, and it should be happening. So it's constantly stimulating if they're doing it properly through clinic multiple days a week.
and then at home on their own as well when they're using their extremity.
Brandy Archie
Do they have any limitations on the number of times they can swipe it when they're at home?
Ashley Mahoney, OTR/L
I to say it's four times, so 30 minute session. It's either four hours or four times. I'm sorry I did not have that one prepped for you guys.
Emilia Bourland
Geez, Ashley, you don't know every single little thing about, so disappointed. Not really, you're amazing.
Ashley Mahoney, OTR/L
I know.
Ashley Mahoney, OTR/L
know I'm like they should be about this that I tell people all the time about this but know that the battery will die after about five years if they're using it all the time so obviously they're just doing the six weeks of therapy but we have patients that just continue doing therapy for you know months if it works for them and insurance and everything insurance does cover this if they get it approved ahead of time and it covers like the sessions the
three times a week for six weeks. It covers it all under just that Viviston package. So you still have your normal visits, you know, the rest of the year that aren't counted into. If like you have a insurance company that's like you only get 30 visits a year of therapy. It does not count towards that. So that is nice. Yeah, that is nice. So it all gets approved through like one big package deal. But yeah, the device, if you're using it all the time, even when you finish, they're showing that the battery lasts for about five to 10 years.
Brandy Archie
Nice.
Ashley Mahoney, OTR/L
And then you can get it replaced if you want, you You can get it replaced or you can get it taken out or maybe you're one of the people who didn't follow through with your exercises, you weren't happy with it and you're like, I want it out now. You can get it out early. So there's a lot of options with that.
Emilia Bourland
Well, this is really exciting stuff. I think it's pretty rare that we have these moments, you know, where essentially like we've been thinking about stroke and stroke recovery in the rehab world for the same way for like decades. And it's not even so much that the way we're thinking about it now has changed and that all of the science and the principles that we've always applied to it, they're still there. It still works like that.
Brandy Archie
Yeah.
Brandy Archie
Yes.
Emilia Bourland
But the ability for this window to be reopened is such a unique opportunity and is so exciting. Thank you so much for coming on the show today to talk about this, Ashley. It's really cool stuff. I hope that folks who are listening are able to go and learn more and get more education on this, find out if it's something that can work for them. Hopefully it can help a lot of people out there.
Brandy Archie
you.
Emilia Bourland
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Brandy Archie
Bye everybody.
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